{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:48:10Z","timestamp":1787510890738,"version":"build-2736575974"},"reference-count":43,"publisher":"The Endocrine Society","issue":"1","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>The diagnosis and differential diagnosis of Cushing syndrome (CS) is often challenging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the 4-mg intravenous dexamethasone suppression test (IVDST) to differentiate CS from normal subjects and subjects with low probability of CS (LPC), and define the cortisol responses in pituitary, adrenal, and ectopic adrenocorticotropin (ACTH) CS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from 140 patients with surgically confirmed Cushing disease (CD), 5 with ectopic ACTH syndrome (EAS), 26 with adrenal CS (AC), and 97 with LPC, from 4 tertiary hospitals between 1995 and 2024 were retrospectively evaluated. Thirty-two controls (normal and overweight\/obese participants with or without type 2 diabetes) were previously studied. Dexamethasone was infused at 1\u2005mg\/h for 4\u2005hours. Plasma cortisol and ACTH were measured at \u221260\u2005minutes, \u22125\u2005minutes, +3\u2005hours, +4\u2005hours, +5\u2005hours and on Day 2 (+23\u2005hours and +23.5\u2005hours). Main outcome measures were the sensitivity and specificity of the IVDST for the diagnosis of CS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Controls showed marked cortisol suppression across Days 1 and 2. In 17 of 97 patients with LPC, Day 2 cortisol overlapped with CS. Day 2 cortisol level of &amp;gt;130\u2005nmol\/L diagnosed CS with 97% sensitivity and 87% specificity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The IVDST is a highly sensitive second-line diagnostic test for CS. False negative results occurred when IVDST is performed during an eucortisolemic phase of cyclic CD. The specificity of 87% emphasizes the importance of long-term follow-up of LPC. The small number of EAS cases is a major limitation in the use of IVDST to differentiate ACTH-dependent CS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/jendso\/bvaf188","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T13:16:18Z","timestamp":1763644578000},"source":"Crossref","is-referenced-by-count":2,"title":["Multicenter 30-Year Data on the 4-Mg Intravenous Dexamethasone Suppression Test in the Diagnosis of Cushing Syndrome"],"prefix":"10.1210","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1059-0257","authenticated-orcid":false,"given":"Caroline","family":"Jung","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne , Fitzroy, VIC 3065 ,","place":["Australia"]},{"name":"Department of Medicine, The University of Melbourne , Melbourne, VIC 3010 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maresa M","family":"Derbyshire","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne , Fitzroy, VIC 3065 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niyati","family":"Jauhar","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Alfred Health , Melbourne, VIC 3004 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Bennett","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Alfred Health , Melbourne, VIC 3004 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duncan J","family":"Topliss","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Alfred Health , Melbourne, VIC 3004 ,","place":["Australia"]},{"name":"Department of Medicine, Monash University , Melbourne, VIC 3800 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reetu","family":"Gogna","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Royal Hobart Hospital , Hobart, TAS 7001 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikola","family":"Markovic","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Royal Hobart Hospital , Hobart, TAS 7001 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R","family":"Burgess","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Royal Hobart Hospital , Hobart, TAS 7001 ,","place":["Australia"]},{"name":"Department of Endocrinology and Diabetes, University of Tasmania , Hobart, TAS 7001 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warrick J","family":"Inder","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Princess Alexandra Hospital , Brisbane, QLD 4102 ,","place":["Australia"]},{"name":"Department of Medicine, The University of Queensland , Brisbane, QLD 4072 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"issue":"1","key":"2025121504420207500_bvaf188-B1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1038\/s41572-024-00588-w","article-title":"Cushing syndrome","volume":"11","author":"Nieman","year":"2025","journal-title":"Nat Rev Dis Primers"},{"issue":"1","key":"2025121504420207500_bvaf188-B2","doi-asserted-by":"crossref","first-page":"101521","DOI":"10.1016\/j.beem.2021.101521","article-title":"Epidemiology and mortality of Cushing's syndrome","volume":"35","author":"Hakami","year":"2021","journal-title":"Best Pract Res Clin Endocrinol 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